Learn Basic MSP Billing

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Chapter 2

Learn Basic MSP Billing

Ultimate Guide to Medical Billing for New Doctors in BC


A Bit Of Background On The MSP Billing Process

The Medical Services Plan  (“MSP”) operates on the honour system. BC physicians submit claims for the insured services they provide to patients and are generally paid by MSP without any confirmation or scrutiny. The Health Insurance BC and the Ministry of Health (MOH) work to provide an accounting mechanism to protect the public purse from potential fiscal abuse by the medical profession. This process is administered under the Medicare Protection Act and Hospital Insurance Act.

The Basics of the MSP Billing Process

  1. The physician sees and treats the patient.
  2. The physician chooses a fee code and submits a claim to MSP (through a billing software) that outlines the service provided, along with the patient diagnosis.
  3. MSP reviews the claim and provides reimbursement upon approval.

What You Need to Know about the MSP Claims Submissions Process

  • Each service provided corresponds to a billing code and a respective dollar amount. The MSP fee codes are set out in the MSC Payment Schedule.
  • Claims must be submitted through the billing software with the appropriate billing code and patient information.
  • The Ministry processes claims on an ‘honour system’ – the initial review of a claim is preliminary and not thorough.
  • Claims undergo a series of computerized checks and are generally processed as submitted to ensure prompt payment.
  • If necessary, claims are later audited through a post-payment review process.

What You Need to Know About MSP’s Payment Schedule

MSP posted a claim submissions close-off dates and payment schedule. For stable cash flow, keep in mind that each MSP deposit will cover about two weeks of work. 

To help you reconcile your billings, please refer to:

Monthly Claim Reconciliation: A Step-by-Step Guide

MSP Explanatory Codes

What You Need to Know About the MSP Audit Process

If MSP notices a conflict or issue in medical billing, they can engage in post-payment review, or audit. In BC, the Ministry of Health system is known as the Billing Integrity Program. Its primary goal is to detect, deter, recover ineligible payments to medical and health care practitioners, and enforce legislation that supports the sustainability of the MSP1.

1https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/billing-integrity-program

In some scenarios, the Canadian Medical Protective Association (CMPA) will engage legal experts and help with the audit process. This assistance usually extends to the end of the review process, but in special circumstances– when review committees commit a fundamental error in law or obviously misinterpret the schedule of benefits–the CMPA will instruct legal counsel to appeal the decision of the paying agencies.

Avoiding an Audit

The following advice from Doctors of BC will reduce the chances of an audit2.

  • Don’t rely on MSP to tell you that you did not bill something correctly. Just because you billed for it and were paid does not mean that you billed correctly;
  • Take the time to document what you do;
  • Read the Preamble to the Payment Schedule and your section of the Doctors of BC Fee Guide;
  • Ensure all lab or diagnostic tests you order are medically necessary;
  • Do not destroy appointment records;
  • Look at your remittances; if something doesn’t look right, phone MSP;
  • If you get advice from MSP billing support, document who, what and when;
  • Be cautious about relying on billing advice from colleagues and private pay companies.

2https://www.doctorsofbc.ca/managing-your-practice/billing-audits/avoiding-audit

What to Expect If You Get Audited

There are four general phases of the post-payment review/audit process.

  • Phase 1: Pre-audit/planning
  • Phase 2: On-site audit
  • Phase 3: Reporting
  • Phase 4: Recovery
Doctors of BC audit process steps with steps for each phase of the process brokent down.
Image courtesy of Doctor of BC – “The Audit Process”

For more information about the audit process, and if you have further questions, you can view the Doctors of BC Audit FAQ.

MSP Billing Process Overview – Getting in a Billing Mindset

If this feels like a lot of new information, it is! 

  1. Review the MSC Payment Schedule and get a sense of how much codes are worth.
  2. Get a sense of how much you make per shift (efforts vs. earnings). MDBilling.ca reports can help with this.
  3. Bill, review, and then modify if necessary.
  4. Orient your month around the submission deadline and the payment cycle.
  5. Bill claims in a timely manner, as it becomes “over-age” when it is 90 days from the date of service.
  6. If you must, start billing now and get your MSP Practitioner number later (refer to Chapter 1).
  7. Ask peers about the locums and codes they use.
  8. Ask colleagues about different rules and billing culture at each hospital.

Start Here

Refer to our MSP billing software how-to section.